The growing number of uninsured in the United States is a major social problem as well as increasingly a political problem.  There are now 47 million Americans (2006) without health insurance including both children and adults. 

The uninsured are in all age ranges, though young adults are most likely to be uninsured.  People in the south and west are more likely to be uninsured than those in the northeast and midwest.  Most uninsured are in families with at least one full time worker.  Hispanics disproportionately have the highest rates of uninsured, but the largest share of the uninsured by far is white Americans. 

The number of uninsured continues to increase each year, primarily reflecting a decline in the rate of employer-sponsored insurance.  Despite increases in public coverage, the uninsured continues to grow in response to the drop in private coverage.  The growth in the uninsured has largely been among adults, but in the last two years, the number of uninsured children has increased as well. 

The consequences of the lack of health insurance are serious.  The uninsured are less likely to use health services and have poorer health as a consequence.

At the Urban Institute, we have produced detailed data on insurance coverage, including the number and characteristics of the uninsured at the national level and for several states.  We have also followed trends in coverage and have written extensively on changes in coverage over the last 12 years.  Much of this work has attempted to tie changes in the U.S economy to the trends in employer-sponsored insurance, public coverage and the uninsured.  We have also:

• examined the offers, eligibility, and take up of coverage at the firm level as well as by people at different income levels;
  
• modeled the impact of unemployment on insurance coverage and Medicaid to understand the relationship between business cycles and insurance coverage; 

• provided assistance to states in understanding their uninsured population and in thinking about ways to solve the uninsured problem; and
• provided estimates of various approaches to extending coverage, including expansions of Medicaid, income related subsidies and employer and individual mandates.

Finally, we have estimated the cost of the uninsured.  What is the value of services that the uninsured use?  How much do they pay for themselves and how much is paid for by others?  Of the amount paid for by others, how much is paid for by federal, state and local governments?